An Overview of Bronchodilators

Bronchodilators are prescription medications used for managing a number of lung conditions, including chronic obstructive pulmonary disease (COPD), asthma, cystic fibrosis, and bronchiolitis. Bronchodilators work by dilating (widening) the airways to help you breathe better.

These medications are typically inhaled through the mouth using an inhaler and are also prescribed in liquid, pill, injectable, and suppository formulations.

Uses and Types

Because bronchodilators have a dilating effect on the bronchi, they relieve issues like sudden constriction (tightening) of the airways. As they do this, bronchodilators can also help alleviate some of the effects of inflammation (which narrows the airways) and infection.

Bronchodilators are available in short-acting or long-acting formulations.

  • Short-acting bronchodilators are typically used on an as-needed basis to alleviate acute breathing difficulties
  • Long-acting bronchodilators are usually prescribed on a daily schedule to prevent breathing problems.

You may be prescribed a long-acting bronchodilator and a short-acting bronchodilator if you have asthma, COPD, allergies, or cystic fibrosis.

Bronchodilators are commonly used for the treatment of bronchiolitis, an acute infection of the airways that tends to affect children. However, their use is controversial when it comes to this condition and not widely agreed on; experts suggest that the value of bronchodilators in treating this condition hasn't been proven.

There are three classes of bronchodilators, and each class works a little differently. Your prescription will depend on your specific condition.

Types of bronchodilators:

  • Beta-adrenergic agonists
  • Anticholinergics
  • Methylxanthines

Beta-Adrenergic Agonists

Beta-adrenergic agonists (also known as beta-agonists) are medications that bind to beta-adrenoceptors, which are located on the muscles that dilate and constrict your airways. These medications activate the receptors that make the muscles of your airways relax so your airways will widen, allowing you to breathe easier.

Beta-agonists can either be short-acting (lasting between four to six hours) or long-acting (lasting 12 or more hours). There are oral and inhaled formulations.

The short-acting beta-agonists (SABAs) currently approved in the U.S. are:

The long-acting beta-agonists (LABAs) currently approved in the U.S. are:

  • Salmeterol (a component of Advair)
  • Performomist (formoterol)
  • Arcapta (indacaterol)
  • Brovana (arformoterol)

Beta-agonist medications are also used in two-in-one formulations such as Symbicort which combines formoterol with an inhaled corticosteroid known as budesonide.

Most beta-agonists can be used for COPD and asthma, and the short-acting formulations are commonly used for treatment of allergies. Albuterol is approved for the treatment of cystic fibrosis.

Drug side effects are usually dose-related and more commonly seen with oral use. The most common ones include high blood pressure, tachycardia (rapid heart rate), heart palpitations, tremors, and sleep disturbances.

These medications are often used with caution in people who have heart disease.

Anticholinergics

Anticholinergics are medications that block acetylcholine, a neurotransmitter released by parasympathetic nerves in the lungs that constricts the muscles of the bronchi. By blocking the action of acetylcholine, anticholinergic medications counteract constriction and spasms in the airways to help you breathe easier.

The anticholinergics currently approved in the U.S. are:

  • Atrovent (ipratropium)
  • Spiriva (tiotropium)
  • Tudorza Pressair (aclidinium bromide)

There is also a combination inhaled formulation called Combivent, which contains ipratropium and the short-acting beta-agonist albuterol.

The most common side effects of anticholinergic drugs are dry mouth and a metallic aftertaste. In rare cases, glaucoma has been known to occur. These medications can also cause cardiac side effects.

Methylxanthines

Methylxanthines are a unique class of drug known to alleviate airflow obstruction, reduce inflammation, and temper bronchial contractions.

These drugs are used for treatment of chronic and acute asthma. They are currently available in either pill, liquid, intravenous, or suppository formulations. However, their mechanism of action is not well understood and, while effective, the drugs are not commonly first-line treatment choices due to their range of side effects.

The two methylxanthine drugs approved in the U.S. are:

  • Theochron (theophylline)
  • Norphyl (aminophylline)

The side effects may include headaches, insomnia, nausea, diarrhea, jitteriness, rapid breathing, and heartburn.

How to Use

If you or your child is prescribed a bronchodilator, it's important that you learn how to use it properly so that you can absorb the medication into your lungs. Using a metered-dose inhaler (MDI) can be tricky at first.

You can ask a provider on your medical team or at the pharmacy to help you learn how to use it or to watch you the first time you try it.

Carefully go through these steps when using your inhaler.

  1. Shake the inhaler thoroughly before using it to ensure that you don't get too much or not enough medication.
  2. Remove the cap from the inhaler's mouthpiece.
  3. Take in a breath and exhale completely.
  4. With the canister pointing upward and the mouthpiece aimed at your mouth, put the mouthpiece into your mouth and close your lips around it.
  5. Take a fast, deep breath through your mouth, while simultaneously pressing firmly on the bottom of the canister.
  6. Hold your breath for five to 10 seconds, allowing the medication to get into your lungs.
  7. Remove the mouthpiece from your mouth and breathe normally.
  8. If your doctor has recommended a second dose of medication, wait for one to two minutes, shake the inhaler again, and repeat steps three through seven.
  9. Replace the cap of the mouthpiece after each use to keep dust and other particles from getting into it.
  10. Rinse your mouth with water after you use the inhaler.

Be sure to ask how to store your medicine, whether you need to pump a few sprays before each use, and how to know when your device is getting empty.

For Your Safety

When you're still having trouble breathing even after using your bronchodilator inhaler, you may be tempted to use it again to give yourself a second dose (or third or fourth) of the medication. Despite the temptation, it's important to stick with the dose prescribed. If you feel as if your medication isn't helping your condition, discuss your concerns with your doctor.

Also, be sure to follow the following safety tips:

  • Don't use your inhaler after the expiration date.
  • Keep your inhaler away from heat and open flames.
  • Never use other people's inhalers and don't share yours with anyone else.
  • Keep your inhaler and all medications out of children's reach.

Don't skip using your inhaler if you can't afford your prescription. There are several discount prescription programs available, and your doctor may be able to provide you with free samples.

A Word From Verywell

Bronchodilators are a mainstay of treatment for many respiratory diseases. Your doctor may also prescribe anti-inflammatory medication, such as a corticosteroid, to reduce inflammation and help you breathe easier.

Was this page helpful?
Article Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Barry PJ, Flume PA. Bronchodilators in cystic fibrosis: a critical analysis. Expert Rev Respir Med. 2017;11(1):13-20.doi10.1080/17476348.2017.1246358

  2. Gadomski AM, Scribani MB. Bronchodilators for bronchiolitis. Cochrane Database Syst Rev. 2014;(6):CD001266.doi:10.1002/14651858.CD001266.pub4

  3. Khaled Almadhoun; Sandeep Sharma. Bronchodilators. StatPearls. Updated September 30, 2019.

  4. Barry PJ, Flume PA. Bronchodilators in cystic fibrosis: a critical analysis. Expert Rev Respir Med. 2017;11(1):13-20.doi:10.1080/17476348.2017.1246358

    dx.doi.org/10.1080/17476348.2017.1246358

  5. Billington CK, Penn RB, Hall IP. β agonists. Handb Exp Pharmacol. 2017;237:23-40.doi:10.1007/164_2016_64

  6. Buels KS, Fryer AD. Muscarinic receptor antagonists: effects on pulmonary functionHandb Exp Pharmacol. 2012;(208):317–341. doi:10.1007/978-3-642-23274-9_14

  7. Kirkland SW, Vandenberghe C, Voaklander B, Nikel T, Campbell S, Rowe BH. Combined inhaled beta-agonist and anticholinergic agents for emergency management in adults with asthmaCochrane Database Syst Rev. 2017;1(1):CD001284. Published 2017 Jan 11. doi:10.1002/14651858.CD001284.pub2

  8. Tashkin DP. The safety of anticholinergic bronchodilators for the treatment of chronic obstructive pulmonary disease. Expert Opin Drug Saf. 2015;14(11):1759-72.doi:10.1517/14740338.2015.1093621

  9. Mahemuti G, Zhang H, Li J, Tieliwaerdi N, Ren L. Efficacy and side effects of intravenous theophylline in acute asthma: a systematic review and meta-analysis. Drug Des Devel Ther. 2018;12:99-120.doi:10.2147/DDDT.S156509

  10. Oñatibia-astibia A, Martínez-pinilla E, Franco R. The potential of methylxanthine-based therapies in pediatric respiratory tract diseases. Respir Med. 2016;112:1-9.doi:10.1016/j.rmed.2016.01.022

Additional Reading